hand plating system

Transcription

hand plating system

hand plating system
Table of Contents
hand plating system
System Overview
• 1.2mm Module ........................................................................................................ 2
• 1.6mm Module ........................................................................................................ 4
• 2.0mm Module ........................................................................................................ 6
• 2.4mm Module ........................................................................................................ 8
• Cannulated Module ............................................................................................ 10
• Hand Fusion Module ......................................................................................... 12
•Instruments ................................................................................................................. 14
Surgical Technique
• Plating - General ................................................................................................... 18
• Plating - Dual Compression .......................................................................... 21
• Plating - Cannulated Screw .......................................................................... 22
• Plating - Subcondylar Plate .......................................................................... 23
• Screw Fixation - Lag Screws ....................................................................... 24
• Screw Fixation - Cannulated ...................................................................... 25
• Hand Fusion ............................................................................................................... 27
1.2mm
Module
Plates
333-1201
1.2mm 6 Hole Straight Plate
333-1206
1.2mm 3 x 8 T Plate
333-1202
1.2mm 12 Hole Straight Plate
333-1207
1.2mm 4 x 8 T Plate
333-1203
1.2mm Y Plate
333-1208
1.2mm Offset Grid Plate, Left
333-1204
1.2mm L Plate, Left
333-1209
1.2mm Offset Grid Plate, Right
333-1205
1.2mm L Plate, Right
Screws
page 2
331-12XX
1.2mm x 4mm – 18mm Fully Threaded Screw
332-12XX
1.2mm x 6mm-18mm Lag Screw
1.2mm
Module
Instruments
320-1061
HPS™ 1.2mm Screw & Plate Module
320-1210
320-1410
320-1610
1.0mm Drill, Manual
1.0mm Drill, J-Latch
1.0mm Drill, Quick Release
320-1213
320-1413
320-1613
1.3mm Drill, Manual
320-1001
1.2mm/1.6mm Plate Holding TAK™
320-1011
1.2mm/1.6mm Plate Holding Threaded TAK™
320-1009
1.2mm/1.6mm Countersink, Manual
320-1112
1.2mm Screwdriver Shaft, Manual
320-1512
1.2mm Screwdriver Sleeve
pg 3
page
1.6mm
Module
Plates
333-1601
1.6mm 6 Hole Straight Plate, Locking
333-1607
1.6mm 4 x 8 T Plate, Locking
333-1602
333-1608
1.6mm Offset Grid Plate, Left, Locking
333-1603
1.6mm Y Plate, Locking
333-1609
1.6mm Offset Grid Plate, Right, Locking
333-1604
1.6mm L Plate, Left, Locking
333-1611
1.6mm Condylar Plate, Left, Locking
333-1605
1.6mm L Plate, Right, Locking
333-1612
1.6mm Condylar Plate, Right, Locking
333-1606
333-1620
1.6mm Subcondylar Plate, Locking
333-1651
1.6mm 6 Hole Straight Plate, Locking, TiA*
333-1652
1.6mm Subcondylar Plate, Locking, TiA*
*Cannot be cut with HPS Plate Cutter
Screws
page 4
330-16xx
1.6mm x 6mm - 24mm Fully Threaded Screw, Angled Locking
331-16xx
1.6mm x 6mm - 24mm Fully Threaded Screw
308-16xx
1.6mm x 6mm - 24mm Lag Screw
1.6mm
Module
Instruments
320-1062
320-1213
320-1413
320-1613
1.3mm Drill, Manual
320-1216
320-1416
320-1616
1.6mm Drill, Manual
320-1001
320-1011
1.2mm/1.6mm Plate Holding Threaded TAK™
320-1009
320-1116
320-1516
pg 5
page
2.0mm
Module
Plates
333-2001
333-2002
333-2003
333-2004
333-2005
333-2006
333-2010
333-2011
333-2012
333-2013
2.0mm Z Plate, Locking
333-2020
2.0mm 4 Hole Straight LCDCP*
333-2021
333-2007
333-2022
333-2008
333-2051
2.0mm 6 Hole Straight Plate, Locking, TiA*
333-2009
333-2052
2.0mm Subcondylar Plate, Locking, TiA*
page 6
2.0mm
Module
Screws
330-20xx
2.0mm x 6mm - 36mm Fully Threaded Screw,
Angled Locking
331-20xx
302-20xx
Instruments
320-1063
320-1215
320-1415
320-1615
320-1715
1.5mm Drill, Manual
1.5mm Drill, Quick Release, Short
320-1220
320-1420
320-1620
320-1720
2.0mm Drill, Manual
320-1002
320-1012
2.0mm/2.4mm Threaded Plate Holding TAK™
320-1010
320-1120
320-1520
pg 7
page
2.4mm
Module
Plates
333-2401
333-2410
333-2402
333-2411
333-2403
333-2412
333-2404
333-2413
2.4mm Z Plate, Locking
333-2405
333-2420
333-2406
2.4mm 2 x 8 T Plate , Locking
333-2421
333-2407
2.4mm 3 x 8 T Plate , Locking
333-2422
333-2408
333-2451
2.4mm 6 Hole Straight Plate, TiA*
333-2409
333-2452
2.4mm Subcondylar Plate, TiA*
page 8
2.4mm
Module
Screws
330-24xx
2.4mm x 6mm - 36mm Fully Threaded Screw, Angled Locking
306-24xx
331-24xx
330-1818
1.8mm x 18mm Locking Buttress Pin
Instruments
320-1064
HPS™
2.4mm Screw & Plate Module
320-1220
320-1420
320-1620
320-1720
2.0mm Drill, Manual
320-1224
320-1424
320-1624
2.4mm Drill, Manual
320-1002
320-1012
2.0mm/2.4mm Threaded Plate Holding TAK™
320-1010
320-1124
320-1524
pg 9
page
Cannulated
Module
K-Wire
316-0133
.028” x 4” K-Wire
316-0107
316-0119
.035” x 4” K-Wire
.035” x 4” K-Wire, Double Trocar
316-0003
316-0123
.045” x 4” K-Wire
.045” x 4” K-Wire, Double Trocar
Screws
319-20xx
2.0mm x 6mm - 36mm Cannulated Lag Screw
317-20xx
2.0mm x 10mm - 36mm Cannulated Headless Screw
319-24xx
2.4mm x 6mm - 36mm Cannulated Lag Screw
317-24xx
317-30xx
page 10
Cannulated
Module
Instruments
320-1055
HPS™ Cannulated Screw Module
316-0116
316-0014
1.7mm Cannulated Drill, Long, Manual
1.7mm Cannulated Drill, Long, Quick Release
316-0322
316-0323
2.4mm Proximal Cortex Drill, Manual
2.4mm Proximal Cortex Drill, Quick Release
316-0005
316-0015
2.3mm Cannulated Drill, Manual
2.3mm Cannulated Drill, Quick Release
316-0317
2.9mm Proximal Cortex Drill, Manual
316-0035
2.0/2.4/3.0/4.0mm Cannulated Drill Guide
316-0101
2.0/2.4mm Cannulated Screw Countersink
316-0135
HPS Dual Cannulated Depth Gauge
316-0310 2.0/2.4mm Headless Tri-lobe Driver, Cannulated, Tapered, Manual
316-0308 2.0/2.4mm Headless Tri-lobe Driver, Tapered, Manual
316-0311 3.0/4.0mm Headless Driver, Cannulated, Tapered, Manual
316-0309 3.0/4.0mm Headless Driver, Solid, Tapered
316-0102
2.0/2.4mm Cannulated Driver, Manual
316-0039
2.0/2.4/3.0/4.0mm Cannulated Screw Remover
page 11
Hand Fusion
Module
2.0mm Fusion Screws*
334-20xx
2.4mm Fusion Screws*
2.0 x16 - 32mm Fusion Screw
334-24xx
2.4 x 20 - 36mm Fusion Screw
Hand Fusion Plates*
333-16141.6mm Fusion Plate
333-20142.0mm Fusion Plate
K-Wire
316-0107 .035 x 4” K-Wire Single Trocar
316-0119 .035” x 4” K-Wire Double Trocar
316-0003.045 x 4” K-Wire Single Trocar
316-0123.045 x 4” K-Wire Double Trocar
Patent Pending*
page 12
Hand Fusion
Module
Instruments
320-1065 HPS™ Hand Fusion Screw & Plate Module
316-1041
316-1042
316-1043
316-1044
20°/25° Fusion Reamer
320-1040Goniometer
316-1046
Depth Gauge
316-1045-03
K-Wire Guide
316-1045K-Wire Guide
316-1017 1.7mm Drill, Quick Release
316-09171.7mm Drill, Manual
316-10202.0mm Drill, Quick Release
316-09202.0mm Drill, Manual
316-1120 2.0mm Fusion Screw Driver Stem
316-1124 2.4mm Fusion Screw Driver Stem
page 13
General Instrumentation Tray
320-1050
HPS™ Instrument Tray
320-1060
HPS™ Two Instrument Tray
Bone and Soft Tissue Management
Selected to aid in fracture realignment and positioning
320-1020
320-1021
6mm Hohmann Retractor
8mm Hohmann Retractor
320-1022
320-1023
3mm Periosteal Elevator, Straight Edge
3mm Periosteal Elevator, Curved Edge
320-1024
Sharp Hook
320-1019
page 14
320-1017
Reduction Forceps
320-1018
Reduction Forceps, K-wire Guide
Termite Forceps
Plate Altering
Designed to easily alter plates to fit varying patient anatomy.
320-1015
Universal Plate Cutter
320-1016
Plate Benders
Plate Holding
intended to facilitate implantation by temporarily securing the plate to the bone
320-1032
On Bone Plate Holder
320-1033
Plate Holding Forcep, Swivel Foot
page 15
Screw Insertion
Precise instrumentation for adequate fixation
320-1003 1.2mm Fully Threaded Screw Drill Guide
320-1013 1.2/1.6mm Screw Depth Gauge
320-1014 2.0/2.4mm Screw Depth Gauge
316-0048
Ratchet Screwdriver Handle
316-0049
Swivel Screwdriver Handle
220-0027 Small Grasping Forceps
page 16
Instrument Tips
•
Plate Holding Taks in plate modules can be inserted into plate holes with a wire pin driver to
temporarily fixate plate.
•
Plate Holding Forcep and On Bone Plate Holders are available to help stabilize plate.
•
Screwdriver shafts are self retaining. Insert Screwdriver straight with force to engage head of
screw. To remove driver tip from screw, rock it slightly from side to side and lift.
•Use Driver
Sleeve to protect soft tissue during screw insertion when necessary and to provide
stability while driving in longer screws.
•
Countersinks are provided for use when placing a headed screw outside a plate. They are
recommended in cases of dense bone to create recess for head of screw.
•
Proximal Cortex Drills are provided for use with Headless Cannulated Screws. They are
recommended to create a larger pilot hole for trailing end of screw.
•
Cannulated Depth Gauge has two sides. “On Plate” side has a flat tip and is designed to hit
surface of plate. “On Bone” side is pointed to allow for accurate measurements at any position.
•
Hand Fusion Depth Gauge is double sided and calibrated for 2.0mm or 2.4mm fusion screw holes.
•
Universal Plate Cutter
•
Place last needed hole around appropriately sized post.
•
Pull plate slightly so it grasps post.
•
Hold plate securely with one hand and squeeze handles to cut plate.
•
Silicone on cutting tip will hold unused part of plate.
•
Remove any plate pieces from silicone before proceeding.
•
Inspect plate for burrs and remove using file located on top of instrument.
•
If cutting pins or tines, use middle section of Universal Plate Cutter marked with black circle.
•
K-wires .045” (1.2mm) or smaller can be cut using tip of Universal Plate Cutter.
surgical technique
hand plating system
Plating
General
Preparation
1
Expose and reduce fracture or osteotomy site
Plate Preparation and Positioning
2
Select plate
Select appropriate plate size and configuration.
3
Cut plate
If necessary plates may be cut using universal plate
cutter, unless noted with * on pages 4-8.
4
Contour plate
Plates are precontoured to anatomically fit bone. If further
contouring is necessary, plate benders may be used.
page 18
NOTE: Bending plate multiple times may weaken
plate and could result in implant failure.
Plating
General
5
Position plate
Position plate over fracture or osteotomy. Use plate
holding TAKs™ for temporary fixation during procedure.
Screw Preparation and Insertion
6
Determine desired screw type
Angled locking, non-locking, lag, or cannulated lag.
Steps 7-10 are for angled locking, non-locking and
lag Screws. Directions for using cannulated lag screws
and compression holes on pages 21-22.
7
Drill
Select appropriate color coded drill guide and insert
into plate hole nearest fracture or osteotomy site.
Determine desired angle of screw placement. Ensure
that screws do not converge.
Drill a pilot hole using the appropriate pilot drill size.
Note: Use irrigation when drilling. Fluoroscopy is
recommended during drilling. In cases of soft bone
drilling with smaller drill (from module 1 size down) is
recommended.
plate size
angled locking
ranges
1.6mm
+ 22°
2.0mm
+ 18°
2.4mm
+ 17°
While screw heads are designed to sit flush with plate,
screw head prominence will vary at severe angles.
Screw head prominence can cause soft tissue irritation.
Angled-locking screws will lock at any angle that drill
guide will allow when fully inserted into plate hole.
Please refer to chart for locking angle ranges.
page 19
Plating
General
8
Measure
Insert depth gauge until it passes through distal
cortex. Retract stem until lip catches against bone to
determine measurement.
Screw Insertion
9
10
Select & insert
Select desired screw diameter and length. Verify
screw length with gauge on block. Insert screw into
plate hole at desired angle to fixate plate onto bone.
Fluoroscopy is recommended during screw insertion
to ensure correct length and angulation.
NOTE: When inserting angled locking screws at
maximum angles stop inserting screw when head has
engaged plate hole. Continuing to drive screw may
cause screw to go through plate. Locking screws and
plate holes can be used up to 3 times.
Repeat steps 6-9 for angled locking,
non-locking and solid core lag screws until all
necessary holes are filled.
Close
11
page 20
Close treatment site using standard closure techniques
Plating
Dual Compression
Using Dual Compression Holes
1.6mm, 2.0mm and 2.4mm plates contain dual-compression holes, allowing for compression regardless
of plate orientation.
Anchor Screw
1
Select hole
Begin with compression holes closest to fracture line.
Compression hole
2
3
4
5
Position drill guide
Place drill guide eccentrically farthest from fracture.
Drill
Measure
Partially insert screw
Do not engage the plate with the screw head.
Compression Screw
6
7
Prepare Compression
Follow steps 1-4 for compression hole opposite fracture.
Fully insert screw
Fully insert screw until head sits in center of
compression hole.
Final Compression
8
9
Return to first screw and tighten
Insert remaining screws following the general plating technique.
NOTE: 1mm of compression is available with each
compression hole. If only 1mm is needed, fully insert a
screw on one side of the fracture and follow compression
instructions for second screw (Steps 6-7).
pg 21
page
Plating
Cannulated Screw
Using Cannulated Lag Screws in a plate
If using a cannulated lag screw through a plate, it must be inserted first before any other screw. Only one cannulated
lag screw can be used per plate.
1
Insert K-wire
Insert .035” K-wire through center of desired hole,
perpendicular to fracture or place plate over kwire
already in place. 1.2mm drill guide for 1.0mm pilot drill
can be used as K-wire guide.
NOTE: Do not bend K-wire when inserting into bone.
2
Measure
Slide plate side of cannulated depth gauge over K-wire
until tip bottoms out on plate; end of K-wire
indicates screw length required. Subtract for any
anticipated interfragmentary compression resulting
from screw insertion.
3
Drill
HPS cannulated screws are self drilling and self tapping,
but drilling is recommended in cases of dense bone.
If drilling is desired or necessary, select 1.7mm
cannulated drill and use 2.0/2.4mm drill guide
located in the cannulated block to drill pilot hole.
4
Insert screw
Select diameter and length of screw needed. Verify
screw length with gauge on block. Insert cannulated
screw over K-wire through plate hole to fixate plate
onto bone and compress the fracture.
5
Remove and discard K-wire.
6
Fill remaining screw holes with solid core screws.
page 22
Plating
Subcondylar Plate
The Subcondylar Plate
The subcondylar plate is designed with a 12° bend in order to sit below the condyles. The 12° bend allows screws
to be placed at broader angles in order to fixate the fracture.
1
Place plate
Position the plate proximal to the condyle.
2
Insert positioning screw
Subcondylar plate has a positioning hole
to aid in precise placement. Drill accentrically, furthest
from plate bend. Measure and insert screw. Do not fully
seat head of screw.
Positioning hole
3
4
5
Insert screws into bent part of plate
Follow steps 6-9 from general plating technique.
Tighten screw in positioning hole
Fill remaining screw holes. Following
general plating instructions
Alternative Condylar Blade Plates are available in 1.6mm, 2.0mm and 2.4mm for indications in
which lateral condylar support and pins/tines are necessary. Instructions for implantation of condylar plates
are as follows:
Drill and measure depth, starting with pin/tine holes first. The 1.6mm and 2.0mm plates have tines
that insert into condyle of bone next to screw. The 2.4mm plates have an angled-locking pin. Cut
pin/tine to desired length using middle section of plate cutter marked by a dark circle.
page 23
Screw Fixation
Lag Screws
Compression with Lag Screws
Lag screws are provided for applications where compression across the fracture line by a screw is advantageous.
Overdrills are also provided to create a gliding hole in the proximal fragment to achieve a lag effect with a
fully threaded screw. To achieve compression, the screw must be placed perpendicular to the fracture line, and
threads must pass into the distal fragment.
1
Drill
Create pilot hole using the appropriate color coded drill
guide and the appropriate pilot drill.
2
Countersink
Countersink to create a recess for screw head.
NOTE: If using a lag screw through a plate, countersink
is not needed.
3
Measure
4
Insert screw
Select appropriate screw diameter and length. Verify
length with gauge on block. Insert screw into hole
perpendicular to fracture/osteotomy. Repeat steps 2 – 5
for additional screw placement.
5
Close the treatment site using standard
closure techniques
page 24
Screw Fixation
Cannulated Screws
Cannulated Compression Screws - Headed and Headless
HPS has 2.0mm and 2.4mm headed cannulated and 2.0mm, 2.4mm and 3.0mm headless cannulated
compression screws. Headless screws provide between 1-2mm of compression. Tapered tri-lobe
driver stems allow headless screws to be inserted below the surface of the bone.
Screw Preparation
1
Insert K-wire
Insert the K-wire to the appropriate depth under
fluoroscopy. Do not bend the K-wire when placing it in
the bone.
2
Measure
Slide on bone side of cannulated depth gauge over
K-wire until tip bottoms out on bone; end of K-wire
will indicate screw length required. Subtract
appropriately for any anticipated interfragmentary
compression resulting from screw insertion.
3
Drill (optional)
HPS cannulated screws are self drilling and self
tapping, but drilling is recommended in cases of
dense bone. If drilling is desired or necessary,
select the appropriate cannulated drill and use the
cannulated drill guide located in the cannulated
block to drill a pilot hole.
NOTE: Use irrigation when pilot drilling.
page 25
Screw Fixation
Cannulated
4
Countersink or Proximal Cortex Drill
Countersinking is recommended when using a
cannulated lag screw to create the required recess in
the bone.
Proximal cortex drill is recommended when using
headless screws to create a pilot hole for trailing end
of screw.
Insert Screw
5
Insert screw
Select screw diameter and length. Verify screw length
with gauge on block. Place screw over K-wire and
use the screwdriver to drive cannulated screw into
bone until desired compression is achieved. Headless
screws will provide 1-2mm of compression.
6
Remove and discard K-wire
7
Repeat steps 1-6 for additional screw
placement
Closure
8
page 26
Close the treatment site using standard
closure techniques
Hand Fusion
Hand Fusion
Hand fusion allows for stable fixation of a joint at a natural resting angle between 20-55°. It combines the
locking plate stability from HPS with the compression provided by the headless screws.
Joint Preparation
1
Expose joint
Make incision on dorsal surface of
proximal bone of PIP joint.
2
Remove damaged joint surfaces
3
Create guide channel in distal canal
Using goniometer for reference, position joint
at desired angle (between 20-55 degrees) and
create osteotomy cuts. Distal bone should be cut
perpendicular to dorsal surface; proximal bone
cut will determine angle of fusion. Cup and
cone configuration can also be used.
From center of joint, drive Ø.045” x 4”
K-wire into distal bone axially to create a
guide channel.
NOTE: In soft bone where drilling for fusion screw
will not be needed, Ø.035” x 4” K-wire can be used
to create a smaller channel. Do not bend k-wire
when inserting into bone.
pg 27
page
Hand Fusion
4
Remove K-wire from
distal bone
5
Place K-wire to determine plate
placement
6
Confirm fusion angle
From center of joint, drive Ø.045” x
4” K-wire into proximal bone through
dorsal cortex at desired angle.
Retrograde K-wire into channel of distal
bone, re-attaching joint. Use goniometer
to confirm angle.
NOTE: Measuring the angle of the K-wire in the
proximal bone relative to the dorsal surface will
also determine fusion angle.
page 28
Hand Fusion
Plate Placement
7
Create a recess in proximal bone for
placement of plate
Select appropriate reamer based on
angle of fusion desired. Place reamer
over K-wire and ream using power, until
top distal edge contacts surface of
bone.
8
9
Place Fusion Plate
Remove k-wire for direct access to the proximal
holes. Select appropriate size fusion plate for
fixation of joint. Cut and bend plate as needed
using appropriate instrumentation from HPS instrument tray. Place plate in divet created by
reamer with transfix hole distal on bone.
Fixate plate to proximal bone
Follow Screw Preparation and Insertion steps in
HPS Surgical Technique (page 17-18) to insert one
locking, non-locking or lag screw from
appropriate HPS module into shaft of plate.
•
1.6 plates use screws from
green 1.6 HPS module
•
2.0 plates use screws from
purple 2.0 HPS module
NOTE: Do not place screw in hole in barrel of plate
prior to placing Fusion Screw.
pg 29
page
Hand Fusion
10
Position bones for fusion
Insert Ø.035 K-wire through transfix hole
and position bones for fusion. Check
positioning under fluoroscopy if desired.
NOTE: Fusion screw WILL NOT fit over Ø.045
K-wire previously used.
11
Measure
12
Drill (optional)
Slide cannulated depth gauge over K-wire
until tip reaches plate; end of K-wire
will indicate screw length required.
If drilling is desired, slide drill guide over K-wire
into transfix hole. Drill hole using appropriate drill
size. Fusion screws are self-drilling and self-tapping
but drilling is recommended in dense bone.
13
NOTE: Use irrigation when drilling. Fluoroscopy is
recommended during drilling. Failure to use
drill guide may inhibit ability to lock screw in
plate.
Select Fusion Screw
Select appropriate Fusion screw diameter and
length from Hand Fusion module, 2.0mm screw
for 1.6 plate and 2.4mm screw for 2.0 plate.
Verify screw length with gauge on block.
page 30
Hand Fusion
Insert Fusion Screw
14
Insert Fusion Screw
Reduce joint; insert screw over K-wire into transfix
hole to compress joint and lock it into plate.
NOTE: Firmly hold distal bone when inserting screw
to prevent malrotation prior to compression and
locking of screw into plate.
Optional Screws:
If solid core screw is desired, use standard screws
in 2.0 HPS module for transfix hole in 1.6 fusion
plate, and standard screws in 2.4 HPS module for
transfix hole in 2.0 fusion plate. Follow Screw
Preparation and Insertion steps in HPS Surgical
Technique Guide. (page 17-18)
15
Fill remaining screw holes
Repeat step 9 to place additional screws until all
necessary holes are filled.
NOTE: If necessary, use only NON-LOCKING
screws in hole in barrel of plate.
Close
16
Place parallel K-wire or screw across joint
if needed for anti-rotation. Close.
MCP and DIP Joints
The OsteoMed Hand Fusion System is approved for use in bone fusion and arthrodesis of phalanges
and metacarpals. Fusion angles range between 20 and 55, and may be too extreme for the DIP joint. If
choosing to fuse the DIP or MCP joint, follow the surgical technique for the PIP Joint.
WARNING: In patients with a large intramedullary canal, the diameter length of the Fusion screw provided
may not provide adequate compression of the MCP joint.
pg 31
page
OSTEOMED
3885 Arapaho Rd.
Addison, TX 75001
Customer Service: 800.456.7779
Outside the U.S.: 001.972.677.4600
Fax: 800.390.2620
Fax Outside the U.S.: 001.972.677.4709
E-mail: customer.service@osteomed.com
www.osteomed.com
p/n 030-1616 Rev.C

hand plating system

Transcription

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